Recovery of Hurricane-Devastated Medical Center Begins With Small Step

GALVESTON, Tex., Nov. 26 -- Eleven weeks after Hurricane Ike turned the University of Texas Medical Branch into a backwater of the Gulf of Mexico, the doors of John Sealy Hospital here swung open for acute care in a symbolic step toward recovery.

But it was a brief moment of triumph for UTMB, the oldest medical complex in the state. Only a few hours later, the hospital shut down again when air quality tests detected evidence of mold spores in the surgical suites. An earlier test had turned up negative.

Ike caused an estimated $710 million in damage to UTMB, closed the complex -- and the city -- for weeks, sent medical students to other campuses across the state for clinical clerkships, downsized the hospital by 350 beds, and cost up to 3,800 positions at the complex.

The psychiatric center may never reopen. The fate of the children's hospital remains unclear, although pediatric services will continue, according to medical center officials.

The hospital has no kitchen, no pharmacy, and no blood bank. Among the clinical services not yet restored are pulmonary and radiation oncology.

Still, UTMB officials are optimistic. They hope to reopen John Sealy Hospital for acute care -- for good -- within a week. Obstetrics and newborn services returned to UTMB a month ago and will remain in operation, as those hospital areas are unaffected by the air-quality issues.

The mold spores were just the latest obstacle thrown in the path of the hospital complex since the Sept. 13 hurricane.

The storm caused relatively little wind damage on the UTMB campus, but the resulting surge from the Gulf of Mexico inundated facilities, flooding an estimated 750,000 square feet. Unlike flooding caused by a sudden downpour or a rising river, the storm surge carried highly corrosive salt water throughout the campus.

Following the hurricane, the city of Galveston remained closed for three weeks. At UTMB patients, students, and nonessential personnel evacuated Galveston ahead of the storm, joining about 45,000 of the city's 60,000 residents. A predefined core of UTMB personnel remained behind.

UTMB's level 1 trauma center stayed open, but not for long. A fire at an adjacent marina consumed dozens of boats, releasing toxic fumes that drifted into the ventilation system serving the trauma center. The trauma center remains closed.

When acute-care services finally resume, patients and visitors will find a shrunken medical center compared with the complex that existed prior to Sept.13.

The pre-Ike medical center had a 550-bed capacity. UTMB will reopen with 200 beds, a number that is unlikely to increase in the foreseeable future. Not yet decided is what will happen to the space formerly used by the psychiatric center and the children's hospital, said Karen Sexton, M.D., the interim executive vice- president and CEO of the UTMB Health System.

The largest employer in Galveston, UTMB had a total workforce of about 8,000 before Ike. In the aftermath of the storm, the workforce could diminish by 50%. This will affect employees at every level, from hourly workers to tenured faculty.

Third- and fourth-year medical students will continue their clinical clerkships at the various medical schools that welcomed them after the hurricane, said Steven Lieberman, M.D., vice dean for academic affairs at the medical school.

"We spoke with our colleagues at medical schools around the state, and they have been unbelievably generous and gracious in hosting our students, putting their faculties' time and effort into continuing our students' education," he said. "We would be in desperate straits without them."

All third- and fourth-year students were placed in clinical clerkships within a week of the hurricane, he added. They are expected to begin returning to Galveston in January. First- and second-year students resumed classes at UTMB on Oct. 20.

The UTMB schools of nursing and allied health sciences also made arrangements for students to receive clinical instruction elsewhere.

Most UTMB physicians moved their clinical practices to the communities that dot both sides of the 50-mile strip of Interstate 45 that connects Galveston and Houston. How many of them will return to Galveston is another of the uncertainties that have to be sorted out in the coming months, said Dr. Sexton.

Academic and hospital accreditation seems safe for now, but some concerns have been expressed about a downsized UTMB's long-term ability to retain accreditation.

In some respects, the hurricane led to a recurrence of longstanding issues, particularly financial matters. For more than 100 years, John Sealy Hospital and UTMB served as the statewide referral center. Patients from the farthest reaches of Texas could be transferred to the center. The vast majority of the transferred patients are indigent.

By 1998 the financial burden of the medical center's historical mandate to serve the state's poor had become "unsustainable," former UTMB president John Stobo, M.D., said in an Association of American Medical Colleges publication. Indigent care costs had reached $260 million annually, and 37% of UTMB patients lacked health insurance and were ineligible for government assistance.

Additionally, the volume of indigent care had increased by 10% for three consecutive years.

At the time, UTMB officials took stock of the situation and formulated a three-prong plan to deal with the economic crisis:

Eliminate some beds and services

Restrict admissions of indigent patients, implement financial screening of all patients, and require payment upfront to see a physician

Limit access to certain expensive drugs and procedures

Though considered extreme by some, the plan restored "balance" to the UTMB balance sheet within a year.

In the aftermath of Hurricane Ike, the financial crisis reared its head again. At a Nov. 12 meeting, the UT System board of regents authorized the massive layoff to deal with a revenue shortfall of about $40 million a month. Without the drastic action, the medical center would run out of cash in three months, the regents noted.

A reduction in operating costs is just the first response to the financial issues confronting UTMB. Others will be required, although they have yet to be determined.

Although Hurricane Ike caused an estimated $710 million in damage, including lost revenue, said Dr. Sexton, the UT System has only $100 million in flood insurance policy, which was the most that could be purchased. The policy provides coverage for the entire system, which comprises six health institutions and nine university campuses.

Dr. Lieberman noted that the medical center's plight might have fallen below the public's radar compared with those in New Orleans after Hurricane Katrina in 2005 and to a lesser extent the massive flooding that destroyed invaluable research projects at Houston's Texas Medical Center in 2001.

Whether UTMB becomes a phoenix in a lab coat, rising from the ashes, remains to be seen. To be sure, the medical center has weathered a multitude of storms, climatic and otherwise: a 1900 hurricane that killed 6,000 Galveston residents and tore the roof off the original medical school building, and major hurricanes in 1915, 1961, and 1983.

UTMB faculty and staff members tend to have strong loyalty to their institution and their community. For them, the medical center's recovery is a foregone conclusion. That view is exemplified by surgeon William Mileski, M.D., who spends more time on academic matters and paperwork while awaiting the reopening of the trauma center that he heads.

"Every time UTMB has been through one of these things, it has come back stronger and more vibrant every time, and I am sure we will again," he said.

Despite the optimism, faculty and staff members know UTMB faces a long and difficult road to recovery. As one unnamed faculty member retrieved belongings from a building that remains closed, he observed, "No matter how many hours I work and how much I do, there's always something else that needs to be done."

Reviewed by Zalman S. Agus, MD Emeritus Professor University of Pennsylvania School of Medicine

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